Does Route Matter? a Randomized Double-Blind Trial Comparing Intravenous and Intrathecal Dexmedetomidine for Prevention of Post-Spinal Shivering in Cesarean Delivery Publisher

Summary: Can dexmedetomidine prevent post-cesarean shivering? A trial found neither delivery route reduced overall rates; spinal dosing delayed onset but lowered blood pressure. #Anesthesia #MaternalHealth

Masaeli M ; Habibzadeh M R ; Sindarreh S ; Faraji T ; Kalantari Sarcheshmeh M S
Source: Shiraz E Medical Journal Published:2026

Abstract

Background: Shivering is a common adverse effect of spinal anesthesia during cesarean section. Dexmedetomidine, a selective α_2-agonist, has been administered via various routes to mitigate this adverse effect. Objectives: This study aimed to compare the efficacy and hemodynamic safety of intravenous (IV) versus intrathecal (IT) dexmedetomidine for preventing post-spinal anesthesia shivering (PSAS). Methods: In this randomized, double-blind, parallel-group controlled trial, parturient women scheduled for elective cesarean section under spinal anesthesia were consecutively screened for eligibility. Eligible participants were randomly assigned in a 1:1:1 ratio to receive IV dexmedetomidine, IT dexmedetomidine, or placebo, using computer-generated block randomization. Allocation concealment was ensured using sealed, opaque envelopes. Patients, anesthesiologists, surgeons, and outcome assessors were blinded to group allocation. The primary outcome was the incidence of PSAS. Secondary outcomes included shivering onset time and intensity, hemodynamic variables, temperature changes, and adverse events. Results: The incidence of shivering was 35.3% in the IV group, 40.0% in the IT group, and 49.0% in the control group (P = 0.373). The IT-DEX group showed a significantly delayed onset of shivering (P < 0.0001) and higher peri-shivering body temperatures (P < 0.0001) compared with the other groups. Mean arterial pressure (MAP) was lower in the IT group at 45 minutes (P = 0.038) and 60 minutes (P = 0.021) after the block. Conclusions: At a fixed dose of 10 µg, neither IV nor IT dexmedetomidine significantly reduced the overall incidence of shivering compared with placebo. However, IT administration significantly delayed the onset of shivering and preserved body temperature. Trial Registration and Funding: Trial Registration: IRCT20240524061880N1 (Iranian Clinical Trial Registry). Funding: This study was funded by the Medical University of Isfahan. Copyright © 2026, Masaeli et al.